BIVentricular versus right ventricular antitachycardia pacing to terminate ventricular tachyarrhythmias in patients receiving cardiac resynchronization therapy: the ADVANCE CRT-D Trial.

Abstract

BACKGROUND:

This multicenter, prospective, randomized, controlled, parallel trial compares the efficacy of biventricular (BIV) versus right ventricular (RV) antitachycardia pacing (ATP) in terminating all kinds of ventricular tachycardia (VT).

METHODS:

Five hundred twenty-six patients implanted with a cardiac resynchronization therapy defibrillator (CRT-D) device were enrolled and randomized 1:1 to either BIV (266) or RV (260) ATP (single burst 8 pulse, 88% coupling interval) and were followed up for 12 months.

RESULTS:

During 12 months' follow-up, 1,077 ventricular episodes in 180 patients were detected and classified: 634 true VTs divided into 69 ventricular fibrillation (VF) (11%), 202 fast ventricular tachycardia (FVT) (32%), and 363 VT (57%). A comparable first ATP efficacy (BIV 65% vs RV 68%, P = .59) was observed in FVT + VT, in VT zone (BIV 62% vs RV 71%, P = .25), and in FVT zone (BIV 71% vs RV 61%, P = .34). A trend toward lower accelerations during ATP applied to FVT was observed in the BIV group (3.5% BIV vs 10.2% RV, P = .163). No syncope/presyncope occurred during ATP for FVT in the BIV group versus 4 events (3.2%) in the RV group (P = .016). biventricular ATP was more effective in treating FVT in coronary artery disease (CAD) patients (P = .032), whereas both modalities presented similar efficacy in patients with non-CAD etiology (P = .549).

CONCLUSIONS:

Antitachycardia pacing is effective in patients implanted with a CRT-D device. No significant differences in efficacy emerged between BIV- and RV-delivered ATP in the general population, whereas BIV ATP seems to present a safer profile in ischemic patients.

• Authors: Maurizio Gasparini, Frédéric Anselme, Jacques Clementy, Massimo Santini, José Martínez-Ferrer, Tiziana De Santo, Elisabetta Santi, Jeorg O Schwab, ADVANCE CRT-D Investigators
• Journal: American heart journal (Am Heart J) Vol. 159 Issue 6 Pg. 1116-1123.e2 (Jun 2010) ISSN: 1097-6744 [Electronic] United States
• PMID: 20569728 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Copyright 2010 Mosby, Inc. All rights reserved.

Topics

• Aged
• Cardiac Pacing, Artificial (methods)
• Defibrillators, Implantable
• Disease-Free Survival
• Electric Countershock (instrumentation)
• Electrocardiography
• Female
• Follow-Up Studies
• Heart Ventricles (physiopathology)
• Humans
• Male
• Prospective Studies
• Single-Blind Method
• Survival Rate
• Tachycardia, Ventricular (mortality, physiopathology, therapy)
• Treatment Outcome